Treatment of Wrist Dorsal Synovial Cyst with Percutaneous Sclerotherapy Using Hypertonic Saline Solution / Tratamento de cisto sinovial dorsal do punho com escleroterapia percutânea utilizando solução salina hipertônica

Abstract Objective To evaluate the efficacy of hypertonic saline infiltration as a sclerosing agent in the dorsal synovial cyst of the wrist. Method Patients of both genders, aged 18 years or older, with clinical and ultrasound diagnosis of synovial cyst, and without any previous treatment were selected. Case series in which 50 patients underwent aspiration of the contents of the cyst and infiltration of the hypertonic saline solution (2 ml sodium chloride solution 20% and 1 ml of lidocaine 2%). The patients were followed up for 24 weeks, when the parameters pain, strength, range of motion, function (quickDASH and Brief Michigan question), recurrence, and complications were evaluated. Results A total of 46 patients were evaluated for 24 weeks, 18 (39.1%) cysts evolved to resolution, and 28 (60.9%) presented recurrence. There was no statistically significant difference in the effect force or in the range of motion. There was no clinically significant difference in the scores of the questionnaires. The most frequent complications were pain and edema. Conclusion Infiltration with hypertonic saline solution for the treatment of dorsal synovial cyst of the wrist showed a recurrence rate of 60.9%.

Resumo Objetivo Avaliar a eficácia da infiltração da solução salina hipertônica como agente esclerosante no cisto sinovial dorsal do punho. Método Pacientes de ambos os sexos, com 18 anos ou mais, com diagnóstico clínico e ultrassonográfico de cisto sinovial, e sem nenhum tratamento prévio foram selectionados. Série de casos em que 50 pacientes foram submetidos a aspiração do conteúdo do cisto e infiltração da solução salina hipertônica (2 ml solução de cloreto de sódio 20% e 1 ml de lidocaína 2%). Seguimento realizado por 24 semanas, durante as quais foram avaliados os parâmetros dor, força, arco de movimento, função (questionários quick disabilities of the arm, hand, and shoulder [quickDASH] e brief Michigan), recorrência e complicações. ResultadoForam avaliados 46 pacientes por 24 semanas, 18 (39,1%) cistos evoluíram para cura e 28 (60,9%) cistos apresentaram recorrência. Não houve diferença estatisticamente significante nos quesitos força e arco de movimento. Não houve diferença clinicamente significante nos escores dos questionários. As complicações mais frequentes foram dor e edema. Conclusão A infiltração com solução salina hipertônica para tratamento do cisto sinovial dorsal do punho mostrou taxa de recorrência de 60,9%.

Fractura aislada del hueso grande asociada a quiste traumático sinovial: presentación de un caso en un niño / Isolated capitate fracture associated with a traumatic synovial cyst: A pediatric case Report

Introducción: Las fracturas aisladas del hueso grande son muy infrecuentes en los niños y se producen por traumatismos de alta energía. Pueden pasar desapercibidas en la valoración inicial y las radiografías solo permiten identificar las lesiones en huesos osificados, por lo que son necesarias pruebas complementarias, como la resonancia magnética, para descartar posibles lesiones del carpo asociadas, sobre todo en menores de 10 años. Se presenta el caso de una fractura aislada del hueso grande con aparición de quiste sinovial por causa traumática en un paciente pediátrico, tratado mediante inmovilización con yeso antebraquial durante cuatro semanas, con buena evolución. Conclusión: El manejo de estos casos depende de la gravedad de la lesión y, aunque por lo común evolucionan bien con un tratamiento conservador, su diagnóstico precoz permite elegir la mejor opción y evitar posibles complicaciones, como la falta de consolidación o la necrosis avascular. Nivel de Evidencia: IV

Introduction: Isolated capitate fractures, caused by high-energy trauma, are rare in children. They can be missed at the initial assessment of the patient and radiographs only allow the identification of lesions in ossified bones, so complementary tests such as magnetic resonance imaging are necessary to rule out possible associated carpal lesions, especially in children under 10 years old. We present the case of an isolated capitate bone fracture with the appearance of a synovial cyst due to trauma in a pediatric patient, treated by immobilization with a short arm cast for four weeks, with good evolution. Conclusion: The management of these cases depends on the severity of the injury. In most cases conservative treatment is enough but early diagnosis allows us to choose the best option and avoid possible complications as nonunion or avascular necrosis. Level of Evidence: IV

No todo dolor de codo es epicondilitis / Not every elbow pain is epicondylitis

Pain located in the lateral aspect of the elbow is a common cause of consultation in the trauma consultation. The most common cause is "lateral epicondylitis," however there are several differential diagnoses that may require different management. There is a case of radial tunnel syndrome secondary to extrinsic compression, with an emphasis on its diagnosis and surgical technique.

Resección de quistes sinoviales por técnica tubular mínimamente invasiva. ¿Abordaje ipsilateral o contralateral? / Resection of synovial cysts by minimally invasive tubular technique. Ipsilateral or contralateral approach?

Introducción: Los quistes artrosinoviales espinales son lesiones infrecuentes que se originan principalmente en la región lumbar. Aunque el tratamiento conservador es posible, la resección quirúrgica es considerada el tratamiento de elección en pacientes sintomáticos. La inestabilidad postoperatoria es una preocupación. Las técnicas mínimamente invasivas (MISS) demostraron ser una alternativa válida que podría disminuir el riesgo de inestabilidad postoperatoria. Objetivo: Describir la importancia de la orientación facetaria en la elección del lado del abordaje (ipsilateral o contralateral) y la conservación de la unión articular en una serie de pacientes operados de quistes sinoviales lumbares por técnica tubular mínimamente invasiva. Material y métodos: Se evaluaron 8 pacientes con quistes sinoviales lumbares operados con técnica tubular mínimamente invasiva. Se analizó en RMN la relación entre la orientación de las facetas articulares y la vía de abordaje seleccionada, se evaluó además la resección de los quistes sinoviales y el grado de preservación facetaria postoperatoria. Información demográfica e intraoperatoria fue detallada. El resultado clínico fue valorado usando la Escala Visual Analógica (VAS) y los criterios de Macnab modificados para medir la satisfacción postoperatoria de los pacientes. El seguimiento mínimo fue de 6 meses. Resultados: Ocho quistes sinoviales fueron operados y resecados completamente. Cinco pacientes presentaron orientación facetaria coronal y 3 sagital los cuales fueron abordados del lado ipsilateral y contralateral respectivamente. En todos los casos se logró preservar al menos 2/3 de la unión facetaria del nivel comprometido. El tiempo promedio de cirugía fue de 110 minutos. Todos los pacientes fueron dados de alta dentro de las 24 hs. Se observó una mejoría de 6 puntos en el VAS. Según la escala de Macnab; 6 pacientes refirieron resultados excelentes, 1 bueno y 1 regular. No se registraron fístulas ni infecciones. Conclusión: La orientación de las facetas articulares definió el lado del abordaje. En facetas articulares con orientación coronal recomendamos el abordaje tubular ipsilateral y en facetas articulares con orientación sagital el abordaje contralateral. Esto permite una excelente exposición del quiste sinovial y la preservación de la articulación facetaria. Ensayos prospectivos con mayor tiempo de seguimiento y cohortes más grandes serían de utilidad para avalar nuestras recomendaciones.

Background: Spinal arthro-synovial cysts are uncommon lesions that largely originate in the lumbar area. Although conservative management is an option, surgical resection is considered the treatment of choice in symptomatic patients. Post-operative instability is of concern, however. Minimally-invasive surgery techniques have proven a valid option which might reduce post-surgical instability. The aim of this paper is to describe the importance of facet orientation in side selection for the surgical approach (ipsilateral or contralateral) and facet joint sparing in a series of patients undergoing minimally-invasive tubular surgery (MITS) for lumbar synovial cysts. Methods: Eight patients with lumbar synovial cysts undergoing MITS were assessed. Pre-operatively, magnetic resonance imaging (MRI) was performed to identify facet joint orientation and aid in surgical approach selection. Post-operatively, MRI was repeated to confirm resection of the synovial cysts and the level of post-surgical facet sparing. Demographic and intraoperative data were recorded, with post- versus pre-operative pain compared using a visual analog scale (VAS), and the modified Macnab criteria used to measure patients' post-operative satisfaction. Minimum post-operative follow-up was six months. Results: Eight synovial cysts were resected completely. Five patients had a coronal and three a sagittal orientation of their facet and were managed with an ipsilateral versus contralateral approach, respectively. In all cases, at least 2/3 of the involved facet joint was spared. Average surgical time was 110 minutes, and all patients were discharged within 24 hours. A mean 6-point improvement was observed in VAS pain severity. Using the Macnab scale, six patients reported excellent results, one a good result and one a fair result. No spinal leaks or infections were reported. Conclusions: Facet-joint orientation determines which side is used for the surgical approach. For facet joints with a coronal orientation, we recommend the ipsilateral tubular approach; while for joint facets with a sagittal orientation, the contralateral approach. This enables both excellent exposure of the synovial cyst and facet-joint sparing. Prospective trials with longer follow-up and larger cohorts are needed to validate our recommendations.

Resección Mínimamente Invasiva de Quistes Sinoviales Espinales. Nota Técnica / Minimally Invasive Resection of Spinal Synovial Cysts. Technical note

Objetivo: Presentar el algoritmo de tratamiento, técnica quirúrgica y resultados de una serie de pacientes con quistes sinoviales espinales resecados con técnica mínimamente invasiva (MIS). Introducción: Los quistes sinoviales espinales se originan a partir de la dilatación y potencial ruptura de la vaina sinovial de una articulación facetaria. La resección quirúrgica es considerada el tratamiento de elección en pacientes sintomáticos. La utilización de técnicas MIS podrían disminuir la disrupción de la faceta articular comprometida reduciendo el riesgo de inestabilidad postoperatoria. Material y métodos: Se evaluaron retrospectivamente 21 pacientes con quistes sinoviales espinales operados mediante abordaje y descompresión MIS, se analizaron los signos, síntomas, tiempo quirúrgico, estadía hospitalaria, evolución y complicaciones. Se utilizó la escala visual analógica (EVA), para evaluar el dolor y la escala de Weiner y los criterios de Macnab modificados para medir la satisfacción posoperatoria del paciente. Resultados: Se trataron quirúrgicamente 21 pacientes (13 mujeres, 8 hombres), el 76,2% (n=16) de los pacientes de la serie no requirió artrodesis, el 23,8% (n=5) restante fue fusionado. Realizamos 13 (61,9%) hemilaminectomías contralaterales, 7 hemilaminectomías ipsilaterales (33,3%) y una laminectomía en el QS S1-S2 con técnica MIS. El seguimiento promedio fue de 26 meses, el tiempo de cirugía fue de 150,33 ± 63,31 min., con una estadía hospitalaria de 2,5 ± 1,78 días. La EVA disminuyó de 8,3 preoperatoria a 2,3 postoperatoria. Siguiendo la escala de Macnab; 16 pacientes refirieron resultados excelentes, 4 buenos y 1 regular, el 95,2% de los pacientes percibió que el procedimiento tuvo mucho/bastante éxito según la escala de Weiner. Conclusión: El abordaje mínimamente invasivo es un procedimiento seguro y eficaz para la resección completa de quistes sinoviales espinales. Proporciona resultados clínico-funcionales excelentes preservando músculos, ligamentos y facetas articulares.

Introduction: Spinal synovial cysts originate from the dilation and potential rupture of a facet joint's synovial sheath. Surgical resection is considered the treatment of choice in symptomatic patients; however, the use of minimally-invasive surgery (MIS) techniques could reduce any disruption of the facet joint involved, reducing the risk of postoperative instability. Objective: To present the treatment algorithm, surgical technique and results in a series of patients with spinal synovial cysts treated by MIS. Methods and Materials: We retrospectively evaluated 21 patients with spinal synovial cysts who underwent therapeutic MIS with decompression. Signs, symptoms, surgical time, hospital stay, course and complications were evaluated. A visual analog scale (VAS) was used to rate pain, while the Weiner scale and modified Macnab criteria were employed to measure patients' postoperative satisfaction. Results: Twenty-one patients were surgically treated with MIS, among whom 76.2% (n = 16) required no arthrodesis; the remaining 23.8% (n = 5) were fused. We performed 13 (61.9%) contralateral hemilaminectomies, seven ipsilateral hemilaminectomies (33.3%), and one laminectomy at S1-S2. The average follow-up was 26 months, surgical time 150.33 ± 63.31 minutes, and mean hospital stay 2.5 ± 1.8 days. The VAS pain rating decreased from 8.3 preoperatively to 2.3 postoperatively. Sixteen patients reported excellent results, four good and one fair. On the Macnab scale, all but one patient (1/21, 4.8%) perceived that the procedure had been very/quite successful. Conclusions: Minimally-invasive surgery is a safe and effective approach for the complete resection of spinal synovial cysts. It provides excellent clinical and functional results, by preserving muscles, ligaments and facet joints.

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

BACKGROUND: To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin. METHODS: Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings. RESULTS: Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen. CONCLUSIONS: Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.

Quiste sinovial en la tibia luego de la reconstrucción del ligamento cruzado anterior: evaluación de 14 pacientes / Synovial cyst in the tibia after reconstruction of the anterior cruciate ligament: evaluation of 14 patients

Introducción: La aparición de quiste sinovial pretibial posterior a cirugía de reconstrucción de LCA es una complicaciónpoco frecuente, de origen multifactorial que puede suceder incluso años luego de la cirugía. El objetivo del presentetrabajo fue analizar una serie de pacientes tratados por esta complicación. Material y métodos: Se evaluaron retrospectivamente 14 pacientes operados de resección de quiste pretibial posterior auna cirugia de LCA entre el año 2008 y 2016. Se analizó el tipo de injerto, técnica quirúrgica e implante utilizado, la clínicadel paciente y el tiempo de aparición de los síntomas. Se realizó una evaluación radiológica pre y post operatoria. Sedescribió la cirugía de resección del quiste y la anatomía patológica. Evaluamos el índice de recidiva. Resultados: Nueve hombres y 5 mujeres con edad promedio de 38 años. El seguimiento promedio fue de 35 meses.Todos operados con isquiotibiales cuádruple y técnica trans-tibial. El tiempo promedio entre la cirugía de LCA y aparicióndel quiste fue de 29 meses. Clínicamente presentaban una tumoración entre 1.1 y 3 cm sin signos de inestabilidad. Através de Rx y RM se evidenció ensanchamiento del túnel tibial en todos los casos. Se rellenó el túnel tibial con injertoóseo en 7 casos. La anatomía patológica informó: 12 quistes sinoviales (5 asociados a remanentes de sutura) y 2 casosúnicamente fibrosis. Un paciente evolucionó con recidiva...

Introduction: Among complications following ACL reconstruction, the formation of a pre-tibial cyst in the site of the tibialtunnel is very rare and might happen even years after surgery. The purpose of this study was to analyze 14 patients with tibialsynovial cyst after ACL reconstruction.Material and method: We retrospectively evaluated patients operated between 2008 and 2016. We analyzed the graftselection and surgical technique for ACL reconstruction, the time between primary surgery and the onset of symptoms andthe clinical presentation. A pre and postoperative radiological evaluation was performed for every patient. Surgical techniquefor cyst excision, histological analysis and culture results were also analyzed. The recurrence rate was evaluated at finalfollow-upResults: Nine patients were male, with an average age of 38 years. The average follow-up was of 35 months. All ACLreconstructions were performed using hamstring graft and a trans-tibial technique. The average time between primary ACLsurgery and onset of the cyst was 29 months. All patients presented a palpable tumor at proximal tibia and a stable knee.The cyst size varied between 1.1 and 3 cm. In all cases, Rx and MRI could appreciate a widening of the tibial tunnel. Thetibial tunnels were filled with cancellous bone in 7 cases. Pathological anatomy reported 12 synovial cysts (5 associated withremaining suture) and 2 fibrosis. One recurrence was reported...

Técnicas percutáneas con ozono en el quiste facetario lumbar: serie de casos / Percutaneous treatment with ozone for the treatment of the lumbar facet joint cyst: a case series

Los quistes sinoviales de las articulaciones facetarias lumbares son intraespinales, pero extradurales. Estos quistes extradurales pueden localizarse en el ligamento intraespinoso, la articulación facetaria, el ligamento amarillo o el ligamento longitudinal anterior. Aparecen más comúnmente en la cuarta o quinta décadas de la vida y son más frecuentes en la mujer que en el hombre. Se han publicado muchas alternativas de tratamiento contra los quistes facetarios, incluidos el seguimiento, la inyección de esteroides, la aspiración percutánea del quiste, la hemilaminectomía o laminectomía bilateral con o sin fijación y la incisión mínimamente invasiva. El objetivo de este trabajo fue describir la evolución clínica y anestesiológica de una serie de pacientes con quistes facetarios, quienes recibieron tratamiento médico con ozono, sin necesidad de intervención quirúrgica. Se presentó la evolución clínica de dos pacientes a los que se les aspiró sus respectivos quistes facetarios y se les inyectó ozono. Una de ellos recidivó y se le aplicó igual tratamiento, cuya evolución ha sido satisfactoria hasta el momento. La aspiración percutánea de los quistes facetarios es un procedimiento eficaz y de mínima invasión, evita la intervención quirúrgica en la columna y la evolución es satisfactoria(AU)

Synovial cysts of the lumbar facet joints are intraspinal, but extradural. These extradural cysts can be located in the intraspinal ligament, the facet joint, the yellow ligament or the anterior longitudinal ligament. They occur more commonly in the fourth or fifth decades of life and are more frequent in women than they are in men. Many treatment alternatives for facet joint cysts have been published, including follow-up, steroid injection, percutaneous cyst aspiration, bilateral hemilaminectomy or laminectomy with or without fixation, and minimally invasive incision. The aim of this study was to describe the clinical and anesthesiological evolution of a series of patients with facet joint cysts, who received medical treatment with ozone, without the need for surgical intervention. The clinical evolution was presented of the two patients who were aspirated their respective facet joint cysts and injected with ozone. One of them relapsed and was given the same treatment, and whose evolution has been satisfactory so far. Percutaneous aspiration of facet joint cysts, an efficient and minimally invasive procedure, avoids surgical intervention in the spine and its evolution is satisfactory(AU)

Diagnóstico diferencial de hernia discal / Diagnostic differences for disc herniation

Disc herniation is a frequent pathology in the radiologist's daily practice. There are different pathologies that can simulate a herniated disc from the clinical and especially the imaging point of view that we should consider whenever we report a herniated disc. These lesions may originate from the vertebral body (osteophytes and metastases), the intervertebral disc (discal cyst), the intervertebral foramina (neurinomas), the interapophyseal joints (synovial cyst) and from the epidural space (hematoma and epidural abscess).

La hernia discal es una patología frecuente en la práctica diaria del radiólogo. Hay distintas patologías que pueden simular una hernia discal desde el punto de vista clínico y especialmente imagenológico que debemos considerar cada vez que informamos una hernia discal. Estas lesiones pueden provenir del cuerpo vertebral (osteofitos y metástasis), del disco intervertebral (quiste discal), de los forámenes intervertebrales (neurinomas), de las articulaciones interapofisiarias (quiste sinovial) y desde el espacio epidural (hematoma y absceso epidural).

Hemorrhagic Lumbar Synovial Cyst after Microscopic Discectomy

Intraspinal synovial cysts are rare but they are being documented with increasing frequency due to improvements in radiological imaging. However, hemorrhage into synovial cysts is uncommon, and affected patients may present with acute onset radiculopathy. This type of hemorrhage is known to result from rupture of fragile neoangiogenic vessels in the cyst wall, due to a traumatic event or anticoagulant therapy. Here, the authors present a rare case of hemorrhagic lumbar synovial cyst caused by spinal instability after microscopic discectomy. To the best of the authors’ knowledge, this is the first report of hemorrhagic lumbar synovial cyst caused by spinal instability following microscopic discectomy in the absence of a traumatic event or anticoagulant therapy. We discuss the pathophysiological mechanism of this uncommon entity and provide a review of the literature.

Juxtafacet Spinal Synovial Cysts

STUDY DESIGN: This was a retrospective study. PURPOSE: To study the surgical outcome of synovial cysts of the lumbar spine through posterior laminectomy in combination with transpedicular screw fixation. OVERVIEW OF LITERATURE: Synovial cysts of the lumbar spine contribute significantly to narrowing of the spinal canal and lateral thecal sac and nerve root compression. Cysts form as a result of arthrotic disruption of the facet joint, leading to degenerative spondylolisthesis in up to 40% of patients. METHODS: Retrospective data from 6 patients, treated during the period of March 2007 to February 2011, were analyzed. All preoperative and postoperative manifestations, extension/flexion radiographs, magnetic resonance imaging, and computed tomography records were reviewed. All underwent surgery for synovial cysts with excision and decompression combined with posterior fixation. The result of surgery was evaluated with Macnab's classification. An excellent or good outcome was considered as satisfactory. Japanese Orthopedic Association Scale was used for evaluation of back pain. RESULTS: All patients included in this study had excellent outcomes as regarding to improvement of all preoperative manifestations and returning to normal daily activities. Only 2 cases developed postoperative transient cerebro-spinal fluid leak and were treated conservatively and improved during the follow up period. CONCLUSIONS: Although this study included a small number of cases and we could not have statistically significant results, the good outcome of decompression of synovial cysts combined with posterior fixation and fusion encouraged us to recommend this approach for patients with juxtafacet synovial cysts.

Postlaminectomy Bilateral Lumbar Intraspinal Synovial Cysts

Lumbar intraspinal synovial cysts are included in the difference diagnosis of lumbar radiculopathy. Developing imaging modalities has result in increased reporting about these lesions. However, the case of bilateral new lumbar intraspinal synovial cysts after laminectomy has been rarely reported. We report of a rare case with bilateral lumbar intraspinal synovial cysts after laminectomy, requiring surgical excision.

Learning Curve Associated with Complications in Biportal Endoscopic Spinal Surgery: Challenges and Strategies

STUDY DESIGN: Descriptions of technical strategies to overcome pitfalls associated with early learning periods in biportal endoscopic spinal surgery (BESS). PURPOSE: To introduce BESS for lumbar spinal diseases (LSDs) and to inform certain challenges to be overcome in mastering the technique. OVERVIEW OF LITERATURE: BESS has shown superior benefits including excellent magnification, a wider range of view by dynamic handling of an endoscope and instruments. Clinical reports, however, have not yet been very revealing for its new introduction into minimally invasive spine surgery. METHODS: To evaluate the learning curve for BESS, the procedures for various LSDs by one surgeon were analyzed in the view of shortening of the operating times and reduction of complications. Reviewing of recorded procedures helped in finding the reasons and the implemented solutions. RESULTS: The 68 cases included 25 for lumbar disc herniation (LDH), 3 for revision for recurred LDH, 39 for lumbar spinal stenosis (LSS) and 1 for synovial cyst. The operation time for the total cases averaged 83.7±33.6 minutes. According to diagnosis, it was 68.2±23.7 minutes for LDH. After the 14th case of LDH, it was nearly constant and close to the average time. One level of LSS needed 110.4±34.4 minutes. Prolonged operation times even in some later cases of LSS were mainly from struggling against blurred vision due to epidural bleeding. There were 7 cases of complications (10.3%) including 2 cases of dural tear, 1 case of root injury, and 4 cases of incomplete decompression on postoperative magnetic resonance imaging. There was no case of symptomatic hematoma or wound infection. CONCLUSIONS: BESS seemed to have a relatively short learning curve period. The overall complication rate in early learning period was 10.3%. These could be avoided by magnified regional views on an endoscope and a clear surgical field by controlling epidural bleeding.

Quiste intra-articular de rodilla: diagnóstico y tratamiento / Knee intraarticular cyst. Diagnosis and treatment

Introducción: El objetivo de nuestro trabajo es presentar una serie de 35 pacientes con diagnóstico de quiste articular de rodilla sintomático tratados de forma quirúrgica. Se describe el algoritmo diagnóstico, los resultados y el índice de recidiva. Material y método: Se evaluaron en forma retrospectiva 35 pacientes con diagnóstico de quiste articular de rodilla los cuales fueron tratados en forma quirúrgica. Excluimos aquellos pacientes con diagnóstico de ligamento mucoide y quiste para-meniscal. Veinte hombres, 15 mujeres, con una edad promedio de 39 años. En todos ellos se realizó una biopsia escisión: 31 a través de una artroscopía y 4 resección a cielo abierto. La clínica variaba entre hidrartrosis, bloqueo articular y dolor inespecífico. En todos los casos se realizó el mismo algoritmo diagnostico mediante resonancia magnética (RM). Se realizó un seguimiento clínico para evaluar recidiva. Resultados: El diagnostico se confirmó a través de anatomía patológica en todos los casos, obteniendo 16 sinovitis vellonodular pigmentada focalizada, 5 quiste mucoide, 4 quiste sinovial, 1 quiste de tejido fibroso, 6 gangliones del LCA y 1 del LCP, 2 fibrosis postoperatorios de LCA y 2 quiste de Baker. Treinta y cuatro pacientes evolucionaron en forma favorable. Un paciente con quiste de Baker complicado evolucionó con una recidiva luego de 6 meses de la cirugía. Conclusión: La RM preoperatoria es de gran importancia, ya que los quistes se pueden localizar en zonas de difícil acceso o no exploradas en forma habitual. Es importante la sospecha de este tipo de patología ya que con un diagnóstico temprano y tratamiento quirúrgico se obtienen resultados satisfactorios. Nivel de Evidencia: IV. Tipo de Estudio: Serie de Casos. Retrospectivo.

Introduction: The objective of this study was to investigate a series of 35 patients diagnosed with symptomatic intraarticular knee cysts and describe the diagnostic techniques and surgical treatment. Materials and Methods: This is a retrospective study involving 35 patients diagnosed with intra-articular knee cysts who underwent surgical treatment. We excluded patients diagnosed with a mucoid ligament and para-meniscal cysts. Twenty of the patients were men, 15 women with an average age of 39 years old. All patients underwent an escitional biopsy: 31 using arthroscopy and 4 with an open resection. Among the clinical variations were hydarthrosis, joint lock and complaints of unspecific pain. All of the mentioned cases were diagnosed using MRI imaging and clinical follow up care in order to evaluate suspicion of relapse. Results: The diagnosis was confirmed through anatomic pathology in all cases, with 16 focalized pigmented villonodular synovitis, 5 mucoid cycts, 4 synovial cysts, 1 fibrosis cyst, 6 ACL ganglions, 1 PCL ganglion, 2 ACL post-operative fibrosis and 2 Bakers cycts. 34 patients showed favorable outcome and one patient with a Bakers Cyst presented complication with a relapse 6 months after the inicial surgery. Conclusion: The pre-operative MRI is of great importance, cycts can be found in areas that are difficult to access or located in areas that are rarely explored. It is important to suspect these types of pathologies due to the fact that an early diagnosis and surgical treatment lead to favorable results. Level of Evidence: IV. Study Design: Retrospective. Case series.

Epiduroscopic Removal of a Lumbar Facet Joint Cyst

Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.

Rare Thoracolumbar Facet Synovial Cyst Presenting as Paraparesis

Spinal cord compressing syndrome due to synovial cyst (SC) of the thoracolumbar spine is a rare clinical condition. In this report we aim to heighten awareness of the thoracolumbar facet synovial cyst as a possible cause of thoracic myelopathy. The SC was removed thoroughly by laminectomy. The patient had an excellent recovery. The etiological and therapeutic aspects are discussed.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report / O cisto sinovial hemorrágico lombar pode causar compressão radicular aguda? Relato de caso

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Cistos sinoviais da coluna lombar são uma causa incomum de dor na coluna e radiculopatia, geralmente com evolução gradual dos sintomas, que são secundários ao comprometimento do canal vertebral. Raramente, há hemorragia intracística, que pode se manifestar de forma aguda com síndrome compressiva radicular ou mesmo medular. Habitualmente, os cistos sinoviais associam-se a doença degenerativa facetária, embora a patogênese não esteja completamente estabelecida. Relatamos aqui um caso em que uma complicação hemorrágica em um cisto sinovial no nível L2-L3, adjacente à interfacetária direita, causou dor lombar e radiculopatia em um paciente em terapia anticoagulante, sendo necessária a ressecção cirúrgica.

Brown-Sequard Syndrome Caused by a Cervical Synovial Cyst

Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-Sequard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-Sequard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty.